Any of you who work and get your health benefits from an employer, especially a large employer, have probably been encouraged or almost forced to engage in a wellness program, with the aim of reducing weight, improving control of diabetes, getting more exercise, having better diet and so on. There has been a long-standing controversy in health research about whether these programs, when properly evaluated, actually make any difference. Like most initiatives aimed at consumers, these don’t have a meaningful impact. No surprise really, they sound great but changing people’s behavior and health doesn’t happen easily or often. One of the leading researchers in this area has a new research letter reviewing the research history and looking at new research at one large employer. While there was somewhat greater employee engagement in health behaviors at this employer over a three year period, there was no change in health measures or outcomes. Doesn’t mean it isn’t important to try to get people to have better health behaviors, just means it is hard to find behaviors that actually make a difference in health. (JAMA Article)
People suffering from Trump Derangement Syndrome, and there are a lot of them in health care, pooh-poohed all his health care innovations. One was to not let the US be a patsy to big drug companies and have prices in the US be tied to what other developed countries pay, which is usually substantially less. A new piece of research finds that in fact, adopting such a policy would result in savings of tens of billions of dollars for both health plans and consumers. (JAMA Article)
Different providers often charge wildly different prices for the same services, with little difference in outcomes. This study found that for cancer cases, institutions that were part of the National Cancer Institute charged far higher prices than did community hospitals for treating the same cancers. These institutions are often academic medical centers and other large research institutions which have significant market share and rip off health plans and consumers mercilessly, making millions and millions of dollars a year and overpaying executives despite being supposed non-profit, tax-exempt institutions. (JAMA Article)
The Medicare program has a traditional, open model fee-for-service arm, and a second option, currently called Medicare Advantage, that allows beneficiaries to sign up with contracted health plans. They typically receive greater benefits and the elimination of cost-sharing. There have long been allegations that Medicare Advantage plans get paid more for the same patient than if that patient was in the fee-for-service system. This study makes that claim again. But these studies uniformly ignore the fact that the fee-for-service fails to comprehensively manage a patient’s health care and that the MA plans often identify health needs which are being ignored in the fee-f0r-service arm. The annual per beneficiary difference is a mere $320, which seems pretty small considering the extra benefits and care management that MA enrollees receive. There is also some coding gaming, but Medicare has encouraged that by its reimbursement design. The Kaiser Foundation, while doing a lot of good work, has become increasingly ideological in recent years and really doesn’t like private health plans, which is ironic considering its history. (Kaiser Article)
Another completely ideological research group is the Commonwealth Fund. It loves to publish misleading research highlighting how bad it thinks the US health care system is compared to those in other developed countries. In doing these comparisons it routinely ignores that the US manages utilization very well, but pays providers a lot. Want to reduce US spending on health care? Reduce clinician pay and hospital pay. Think that will lead to better quality? The analyses also fail to account for the US’ far worse health behaviors–drug and alcohol abuse, smoking, obesity, high levels of accidents and homicides, etc. We keep focussing on bullshit “equity” and ignoring personal responsibility for health, so things aren’t going to get better on these measures. There is a reason why people come to the US for the best treatment when they are seriously ill and it isn’t because our health system is so bad. These idiots are blinded by fervor for a single payer system, so can’t see what the real problem in the US is–a lot of people engaging in bad health behaviors get gold-plated health coverage through Medicaid, and other payers, with no incentive to improve their health and health behaviors. (CW Fund Report)
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spot on ! My husband and I have been saying since Obamacare – it has done nothing but drive up costs. When then President Trump tried to lower drug costs the drug companies beat him back. And when we had a Republican majority in 2017-18 to be able to make changes – Paul Ryan jumped to the ignorant Russian Hoax side of life.
The increased number of Wellness Plans we are offered thru my husbands large employer is crazy in that your analysis is true- very few actual long term healthy habits come out of these challenges.
Can you steer me to a good layman’s explanation of the economics of the Medicare Advantage plans? I am Medicare FFS, and have argued with my [elderly, also] neighbors that the “Silver Heels” health club and other zero-additional-premium benefits they obtain (but may or may not use) via their MA plans have an invisible cost that someone, somewhere, is paying. I am certain that the providers of the extra MA benefits are not losing money on their deals. But I cannot find a really good, clear explanation to support my belief. Your reference to the $320 beneficiary “difference” touches on my question. That is the first reference to MA cost differential that I have seen. Is relevant data reported anywhere that I can look?
Medicare Advantage plans have low premiums and cost-sharing because they manage care more closely resulting in fewer hospitalizations in particular. So they use those savings to offer beneficiaries more benefits. The supposed extra cost to the Medicare program is largely an artifact of the more comprehensive job of coding all health issues a person may have, which results in higher payments. Medicare attempts to adjust for this upcoding, but probably needs to make a higher adjustment. Journals like Health Affairs have studies on relative costs, the Congressional Budget Office has done work, if you google, you can find other studies as well comparing Medicare Advantage to fee-for-service Medicare.